S7) Urinary Incontinence

Question 1

What is urinary incontinence?

Answer 1

Urinary incontinence is the unintentional passing of urine due to loss of bladder control

Question 2

There are different types of urinary incontinence.

Identify them

Answer 2

• Stress Urinary Incontinence
• Urge Urinary incontinence
• Mixed Urinary Incontinence
• Overflow Incontinence
• Over active Bladder
• Functional

Question 3

What is stress urinary incontinence?

Answer 3

Stress Urinary Incontinence is the involuntary leakage of urine on effort, exertion, sneezing or coughing

Question 4

What is urge urinary incontinence?

Answer 4

Urge Urinary incontinence is the involuntary leakage of urine accompanied by urgency

Question 5

What is mixed urinary incontinence?

Answer 5

Mixed Urinary Incontinence is the involuntary leakage of urine associated with urgency and also with exertion, effort, sneezing or coughing

Question 6

What is overflow incontinence?

Answer 6

Overflow incontinence is the involuntary leakage of urine from an overfull bladder, often in the absence of any urge to urinate

Question 7

Have an understanding of the prevalence of urinary incontinence with age

Answer 7

Question 8

Describe the incidence of the different types of urinary incontinence

Answer 8

Question 9

Identify 6 risk factors for urinary incontinence

Answer 9

• Obesity → reduces abdominal pressure
• Age
• Gender (more common in females)
• Smoking → increases straining (effort needed to wee)
• Family history
• Neurological disease/diabetes
• Race
• any neurological or anatomical abnormalities

Question 10

Identify and describe 4 causes of urinary incontinence in females

Answer 10

• Pregnancy – due to hormonal changes and uterine expansion
• Childbirth – weakens muscles needed for bladder control and damages bladder nerves and supportive tissue
• Hysterectomy – due to possible damage of the supporting pelvic floor
• Menopause – due to loss of oestrogen which causes urethra and bladder to deteriorate

Question 11

Identify and describe 4 causes of urinary incontinence in males

Answer 11

• Prostate cancer – often incontinence occurs as a side effect of treatments
• Enlarged prostate gland – benign prostatic hyperplasia (more common in older men)
• Prostatectomy – often surgery damages urinary structures
• Prostatitis – prostate swells and compresses urethra

Question 12

State 4 initial investigations for urinary incontinence

Answer 12

• Urine dipstick (UTI, haematuria, proteinuria, glucosuria)
• Non-invasive urodynamics (frequency-volume chart, bladder diary)
• Invasive urodynamics (pressure-flow studies, pad tests)
• Cystoscopy (camera in bladder)

Question 13

In the conservative management of urinary incontinence, identify 5 general lifestyle interventions

Answer 13

• Modify fluid intake
• Weight loss
• Stop smoking
• Decrease caffeine intake (UUI)
• Avoid constipation

Question 14

Identify 3 forms of management for patients with urinary incontinence who are unsuitable for surgery / failed conservative management

Answer 14

• Catheter (suprapubic/urethral)
• Sheath device
• Incontinence Pads

Question 15

What is the initial management for SUI?

Answer 15

Pelvic floor muscle training – 8 contractions x3/day, at least 3 months duration

Question 16

What is the pharmacological management for SUI?

Answer 16

Duloxetine – combined noradrenaline and serotonin uptake inhibitor increases activity in the striated sphincter during continence phase

keeps noradrenaline in the bladder for longer and so bladder can be full for longer and the external sphincter can be kept close

Question 17

Identify 2 types of surgical management for males with SUI?

Answer 17

• Artificial urinary sphincter (external)
• Male sling procedure

Question 18

Identify 2 types of surgical management for females with SUI

Answer 18

• Low-tension vaginal tapes (permanent)
• Intramuscular bulking agents (temporary) - thickens the wall of the urethra at the bladder outlet so its easier to hold in urine
• vaginal tapes - help keep the bladder and urethra closed

Question 19

What is the initial management for UUI? (urgency urinary incontinence)

Answer 19

Bladder training – scheduled voiding for at least 6 months duration

Question 20

Identify and describe 2 types of pharmacological management of urinary incontinence

Answer 20

• β3-adrenoceptor agonist increases bladder’s capacity to store urine
• Anticholinergics act on muscarinic receptors to promote urine retention

Question 21

Identify 4 types of surgical management for UUI

Answer 21

• Sacral nerve neuromodulation
• Autoaugmentation (change size or shape of the bladder)
• Augmentation cystoplasty
• Urinary diversion

Question 22

what are two types of natural diuretics

Answer 22

• coffee
• tea

Question 23

what is an over active bladder

Answer 23

• the need to suddenly urinate frequently that is difficult to control

Question 24

What are some common symptoms if someone is suffering from a Storage issue

Answer 24

• increased frequency of urination
• urgency
• nocturia
• incontinence

Question 25

what are some common symptoms if someone is suffering from voiding issues

Answer 25

• slow stream
• splitting or spraying
• intermittency
• hesitancy
• straining
• terminal dribble

Question 26

what are some common symptoms if someone is suffering from post maturation issues

Answer 26

• dribble
• feeling incomplete of emptying

Question 27

some signs of a mixed UI

Answer 27

• fluid intake habits (tea/coffee)
• previous pelvic surgery
• history of large babies
• signs of uterovaginal prolapse

Question 28

what dermatomes should you examine if someone has UI

Answer 28

S2,3,4 keeps the wee and poo off the floor

Question 29

what are some examinations that you should

Answer 29

• BMI
• abdominal exam to examine the bladder and see if its palpable
• examine S2-4 dermatomes
• digital rectum examination
• females - external genitalia (stress test) and vaginal exam

Question 30

urodynamics testing

Answer 30

• intravesical pressure → pressure in bladder
• detrusor pressure → stress incontinence